Pharmacology ATI Study Guide

THYROID REPLACEMENT
Examples Levothyroxine sodium (Synthroid, Levothroid, Levoxyl, Unithroid) Liothyronine sodium (Cytomel) Thyroid (Armour Thyroid) Liotrix (Thyrolar) Hypothyroidism: Depression Weight Gain Bradycardia Anorexia Cold intolerance Dry Skin Menorrhagia Myxedema Coma (IV emergency tx) Signs of Hyperthyroidism: Anxiety Tachycardia Palpitations Altered appetite Abd cramping Heat intolerance Fever Diaphoresis Weight loss Menstrual irregularities 4 hrs apart from vitamins, antacids, iron, & Carafate Monitor & report signs of cardiac excitability (angina, chest pain, palpitations, dysrhythmias) Monitor T4 and TSH Take on empty stomach Lifelong replacement, dont d/c abruptly Check w/ provider before switching brands Preg Category A Caution in preg & lactation CI in Thyrotoxicosis Caution: CV problems (HTN, angina, ischemic heart disease) CI following an MI due to cardiac stimulant effects Not used in tx for obesity

Indications

Side Effects

Administration

Contraindications

INSULIN
Only regular insulin may be given IV Side effects: o Lipohypertrophy (rotate sites & leave 1 inch between injection sites) o Hypoglycemia If abrupt onset SNS sx (tachycardia, palpitations, diaphoresis, shakiness) Gradual PNS sx (HA, tremors, weakness) Administer 15 g carb (4 oz OJ, 2 oz grape juice, 8 oz milk, glucose tabs) If unconscious, administer IV glucose or glucagon Interactions o Sulfonylureas, meglitinides, beta blockers, & ETOH hypoglycemic effects o Thiazide & glucocorticoids glucose levels Generic (Trade) Lispro insulin (Humalog) Insulin glulisine (Apridra) Regular insulin (Humulin R or Novolin R) NPH insulin (Humulin N) Insulin detemir (Levemir) Insulin glargine (Lantus) Onset <15 mins. Peak 0.5 1 hr Duration 3 4 hr

Classification Rapid-acting

Short-acting

0.5 1 hr

2 3 hr

5 7 hr

Intermediateacting

1 2 hr

4 12 hr

18 24 hr

Long-acting

1 hr

None

10.4 24 hr

ORAL HYPOGLYCEMICS
Medications Sulfonylureas: 1st Generation: o Tolbutamide (Orinase) o Chlorpropamide (Diabinese) nd 2 Generation: o Glipizide (Glucotrol) o Glyburide (DiaBeta, Micronase) Expected Pharmacological Action

Results in insulin release from the pancreas

o Glimepiride (Amaryl) Meglitinides: Repaglinide (Prandin) Nateglinide (Starlix) SE: hypoglycemia Food/Med intxns: o Gemfibrozil (Lopid) risk of hypoglycemia SE: o GI effects (anorexia, N&V,) o Vit B12 & folic acid deficiency o Lactic acidosis (hyperventilation, myalgia, sluggishness, somnolence) Med/Food Intxns: o ETOH risk of lactic acidosis SE: o Fluid retention o LDL o Hepatotoxicity Med/Food Intxns: o Gemfibrozil: risk of hypoglycemia o Insulin: risk of hypoglycemia SE: o Abd distention & cramping; hyperactive bowel sounds; diarrhea; excessive gas o Anemia o Hepatoxicity Med/Food Intxns: o Sulfonylureas & insulin: risk of hypoglycemia o Metformin: added GI effects & risk of hypoglycemia

Biguanides: Metformin HCl (Glucophage) Thiazolidinediones (Glitazones): Rosiglitazone (Avandia) Pioglitazone (Actos)

Alpha glucosidase inhibitors